=====================================================
General NPI Number Information
=====================================================
NPI Number | 1720868615
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JENSINE TIFFANY SWICK APRN, BSN, RN
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/29/2023
-----------------------------------------------------
Last Update Date | 09/29/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 36000 EUCLID AVE
-----------------------------------------------------
City | WILLOUGHBY
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44094-4625
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 440-953-9600
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 30545 WILLOWICK DR
-----------------------------------------------------
City | WILLOWICK
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44095-3746
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 330-357-1648
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LA2100X
-----------------------------------------------------
Taxonomy Name | Acute Care Nurse Practitioner
-----------------------------------------------------
License Number | APRN.CNP.0035023
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------